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facts
Malawi
• Population: Approximately 15,000,000
• Area: 118,484 km2
• Life expectancy: 49 years
• Child mortality 2008: Ten per cent
• 46 per cent of births take place without
professional help.
"The intention was to build this project
as an exchange of professionals between
Norway and Malawi. We wanted to
supply professionals to train local health
personnel, and to offer Malawian health
workers a chance to practice in Norway,"
says Odland.
Siri Skrøppa, a doctor at the Ullevål Uni-
versity Hospital, is one of the Norwegian
health workers who has gone on exchan-
ge to the Bwaila central hospital in
Lilongwe. She describes the demands of
a typical day in the Lilongwe maternity
clinic in a professional journal,
Gyneko-
logen
(Gynaecologist):
"Over the course of a day, there are
typically 30 to 40 births in a delivery
room that has 14 beds. The mothers are
all alone, and often young and afraid.
They need to bring or buy a black plastic
sheet that they put on the thin plastic
mattress to minimize soiling from blood
and amniotic fluid. There are only two
or three midwives on duty, who must
also assist with any Caesarean sections.
Often, women give birth on the floor
because all the beds are full. On average,
one woman dies every week in Bwaila,
while more than one child dies there
each day. The vast majority of women
die of bleeding, infections and eclampsia
and because they come too late to the
hospital."
Better use of resources
Odland believes that these very high
child mortality rates have negative
consequences for Malawian society as a
whole.
"This means that a substantial part of
next generation does not grow up, or is
sick and malnourished. By and large,
child mortality is a metaphor for the
socio-economic conditions in a society.
Therefore, primary health services and
good prenatal care with access to good
nutrition are the most important tools to
improve the situation.
Malawi has major challenges related to
a lack of resources, such as water and
food. Wouldn't reducing child mortality
lead to even more acute competition for
these resources because there will be more
people to feed?
"No, quite the contrary. With better child
health there will be more people who
have the ability to procure these resour-
ces. Malawi has not had a famine in the
last 30 years. However, their diet is very
simple, with a lot of corn porridge. The
country's biggest nutritional problem is
malnutrition, not undernourishment.
Half give birth at home
The fourth goal of the UN's Millen-
nium Development Goals is to reduce
child mortality by two-thirds by 2015
compared to 1990. Malawi is one of
the 23 countries that the World Health
Organization (WHO) and UNICEF say
is on schedule to achieve this objective:
From 1990 to 2008, child mortality was
reduced from 225 to 100 children per
1000 inhabitants.
What is the reason behind this huge
reduction?
"It's partly a bit of numbers magic. The
actual records are very inexact, as long
as half of all births take place outside of
institutions, with midwives without qua-
lifications and inadequate recording. The
figures are always the worst in the first
phase when we start recording all births
in a population. Malawi has a high child
mortality rate nevertheless, even at 100
out of 1000. And the maternal mortality
rate in Malawi is still one of the very
highest in the world."
Good intentions, negative
results
Fifteen midwives have already been
fully trained through the project, while
the first class of gynaecologists is now
being educated. In the process of trai-
ning health workers in Malawi, however,
Odland also learned that the efforts
of other Western aid and charitable
organizations might contribute to weake-
ning the country's already shaky health
care system. He cites the example of the
Gates Foundation, a private non-profit
organization started by the Microsoft bil-
lionaire Bill Gates, which established an
HIV project in the Lilongwe maternity
clinic in 2008.
"The Gates Foundation paid the best
midwives a double salary for a period to
conduct research on the development
of the fight against HIV and AIDS in
Malawi. Aside from the fact that this
research work was essentially super-
fluous, it also meant that midwives left
the maternity ward after the project was
done because they did not want to work
for ordinary Malawian salaries anymore.
This seemingly generous assistance has
thus led to further damage to the health
care sector," he says.
Malawi is often plucked out as one of
the countries in the south that illustrates
the greatest challenges posed by "brain-
drain" in the health sector. Odland
stresses that brain drain is about more
than health professionals who migrate to
Western countries.
"When we started the birthing pro-
ject in Lilongwe, there was only one
doctor who had specialist training in
gynaecology there. She now works at a
private clinic in Malawi, which only the
richest can afford, because she is better
paid and has a better work situation
there. Additionally, both neighbouring
countries and Western countries are an
important labour market for health care
workers from Malawi," Odland says.
Sources: UNICEF and WHO Report: Countdown to 2015
Gynekologen, the academic journal
University of Tromsø –
Labyrint E/11
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Text:
Askild Gjerstad